EVALUAREA UTILIZARII SERVICIILOR SPITALICESTI DUPA APLICAREA MASURILOR DE RESTUCTURARE, ROMANIA, mai 2011

Hospital system in Romania is one of the most burdened hospital system in Europe. At least in theory, the restructuration decision of the hospital sector, which affected 13% of hospitals in Romania (66 hospitals) was conducted according to best practices (as contained in the reform plan, guidance and grounding decision by contributing experts: specialist committees, expert consultation etc. list of recommendations, objective, etc.). Currently, there are no signs that draw attention to imbalances caused by this implementation.One year after application of Governmental Decision, hospital activity decreased significantly (by 10%, both in terms of hospitalization days and number of hospitalization episodes) and the assumption that the remaining hospitals in the counties will be overloaded with patients is invalidated for this first year of evaluation. Time will determine if there is any negative impact, and that other political and strategic measures to be supported by other consistent measures [1] (Development of National, Regional and Local hospitals plans, reduction of hospital overcapacity for admission, classification and accreditation of hospitals, review of hospital financing and so on).Reconfiguration of the health system had been applied to smaller scale, and this decision proves to be necessary and also politically brave considering that is anti-popular. Weaknesses points are plenty and one of them would be the time to apply so radical measures, due to the gap in reforming other medical sectors, beside poor alignment of measures to reform the healthcare system as a whole. Keywords: assessment, hospitals, restructuring, Romania, access.Sistemul spitalicesc din Romania este unul dintre cele mai impovarate sisteme spitalicesti din Europa. Cel putin la nivel teoretic, declarativ, procesul luarii deciziei de retructurare a sectorului spitalicesc, ce a afectat 13% dintre spitalele din Romania (67 spitale), s-a desfasurat conform celor mai bune practici (masura cuprinsa in planul de reforma; consiliere si fundamentarea deciziei prin contributia expertilor: comisii de specialitate, consultare experti etc; lista cu recomandari; criterii obiective etc). La momentul actual, nu exista semnale care sa atraga atentia asupra unor dezechilibre produse de implementarea acestor masuri.La un an dupa aplicarea HG, activitatea spitaliceasca a scazut semnificativ (cu 10%, atat in ceea ce priveste zilele de spitalizare, cat si numarul episoadelor de spitalizare), iar ipoteza ca spitalele din judetele neafectate vor fi supraincarcate cu pacienti extrateritoriali este infirmata pentru acest prim an de evaluare. Ramane ca timpul sa stabileasca daca exista vreun impact negativ, iar in plan politico-strategic, masurile luate sa fie sustinute de alte masuri coerente (elaborarea Planului national privind spitalele si a planurilor regionale si locale privind spitalele; reducerea capacitatii excedentare de internare; clasificarea si acreditarea spitalelor; revizuirea finantarii spitalelor etc.). Reconfigurari ale sistemului au mai fost aplicate, la scala mai mica, iar decizia luata reprezinta o decizie necesara ce dovedeste si un act de curaj in luarea unor decizii antipopulare. Punctele slabe sunt destule, iar unul dintre acestea ar fi reprezentat de momentul aplicarii unor masuri atat de radicale, datorita decalajului fata de reformarea celorlalte sectoare medicale, si datorita unei slabe corelari a masurilor de reformare a sistemului sanitar in integralitatea sa. Cuvinte cheie: evaluare, spitale, restructurare, Romania, acces